Provider Demographics
NPI:1205941390
Name:DESOUSA, DAWN (MS)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DESOUSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2693
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95812-2693
Mailing Address - Country:US
Mailing Address - Phone:916-566-4742
Mailing Address - Fax:
Practice Address - Street 1:2335 AMERICAN RIVER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7065
Practice Address - Country:US
Practice Address - Phone:916-566-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist